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I start most days with a nice cup of tea and a scroll through the various news and social media platforms to see what is going on in the world of wellness.

This morning it was twitter that caught my eye with the hashtag #InternationalDayOfHappiness which was trending as I started planning the day.

When I say caught my eye, this hashtag was one of those things that immediately invoked a response, something I felt I had an opinion on. Of course the problem with snapshots like this is that they don’t give you any context so on the surface my interpretation of this hashtag is that the intention is that everyone should be happy today. As someone who changed their career to the pursuit of better wellbeing I feel that there are few problems with such a simplistic view, however well intentioned. My intention here is not to pour salt all over happiness, but to explain why I feel its pursuit as a life goal is potentially flawed and offer a different perspective that will enhance our sense of wellbeing.

So is International Day of Happiness all about making people happy?

Its not that simple. The principle is that the world is such a negative place, for one day, it is nice to flood our periphery with joy and happiness.

Sounds great, what wrong with that?

All over the world, thousands of people will feel the benefit. There are many others who wont. For some people, happiness is simply not within their grasp and certainly its not going to happen by telling them to be. The problem with flooding their world with happiness is that it simply reinforces their own unhappiness. We see this already at Christmas time, when our community feels an overwhelming pressure to feel joyful. Its well documented that those suffering from depression, loneliness or isolation will feel the effects particularly at this time of year.

Let’s just make them happy then!

If someone is unhappy, no amount of tom foolery or coercion is going to make them happy. The problem is that happiness is not a perpetual state of mind, its an emotion just like anger, fear and worry. Emotions when expressed appropriately are a normal response to situations we find ourselves in. For example, we feel fear when faced with danger. This is entirely appropriate and triggers a hormonal response in our bodies that alters how we function in preparation for responding to the threat. The natural expression of a broad range of emotions is normal, healthy and part of living a well balanced life. It becomes a problem when these emotions cant be switched off or become overly expressed. Happiness is no different. It would be highly inappropriate to feel happy when faced with a dangerous situation or grief.

So you don’t want people to be happy then

That’s not what I’m saying. I think people should express happiness, sadness, anger and all of the other emotions freely and appropriately without fear of judgement or ridicule. Setting your sights on “acquiring” happiness however is fundamentally flawed in the same way as being motivated by money.

What I consider to be problematic is how we define happiness. In our modern world, driven by consumerism and, lets be honest here, greed, happiness as some understand it is inexplicably intertwined with the acquisition of goods. There are other extremes too. For example, some people feel happiness when they are driving a vehicle at break neck speeds or from stealing other peoples possessions. Happiness in itself is not an exclusively virtuous or wholesome pathway and it is by no means an absolute right to feel happy if there is a cost to others.

So what do you suggest instead

I believe in a values based approach to setting life goals, working to the best of our ability to do what we feel is right and aligns with the person we truly want to be. Self compassion and compassion for others, if we follow this path, happiness may reward us along the way but we will achieve an overall sense of contentment and personal wellbeing, in my opinion a more achievable and sustainable goal.

We all know what the intention of the day is. Your making a bit of a big deal out of a few words aren’t you?

I don’t think so. The hashtag I saw this morning invoked an immediate response from me because of the language used. As humans have evolved, particularly over the last few years, our language and use of it has developed enormously. The addition of new words into our vocabulary and the change in culture have affected how we interpret language. We have a duty to take care over the choice of words we use and at very least to discuss and rationalise how we interpret themes. This isn’t judging something as right or wrong, simply opening the opportunity to broaden our discussions and consider different perspectives. That is why I offer this opinion, not to spoil the fun.

I’m sure people will disagree with me. This is what makes us develop as human beings and I welcome the variety of opinion that supports or contradicts my own. That is after all what keeps the conversation going and the human mind developing. I hope you have enjoyed reading this and if so, or if not, please comment.

On Friday I was fortunate enough to attend a fascinating presentation on Seasonal Affective Disorder (SAD), a keen interest of mine, particularly as I have become more emerged in holistic wellbeing and the part that lifestyle has to play in our overall health.

For those not in the know, SAD is an illness which see’s sufferers mental health plummet at a particular point in the year, usually as the days become shorter. I have written a more detailed piece on the condition which you can read by clicking here.

The event was attended by a broad cross section of peopled despite being a presentation from one of the world leading authorities became a well managed interactive exchange of perspectives. One of the conversations had me particularly interested, an attendee who was interested in the potential of building light therapy into existing light sources as apposed to the existing methods which usually require a sufferer to sit in front of a light for up to 30 minutes.

To be clear, I think this is a great idea. Anything that can help alleviate suffering without ingesting chemicals can only be a good thing. What interested me however was some of the rationale that sat behind the market for such a product which was aptly summarised as, “people don’t have 30 minutes to sit in front of a light in the morning”.

What immediately struck me from this statement is the disparity with which mental health is held next to physical health. So lets be clear, SAD is a serious mental illness. Mental illness is a serious medical complaint that can lead to disabling symptoms and death. In certain demographic groups, the mortality from mental illness exceeds that of any other illness. Yet if we had a physical illness that necessitated 30 minutes of physical therapy a day, we would move heaven and earth to make sure that person received. Would we see dialysis or chemotherapy as a choice? Of course not, nor should we. So why when the problem is a mental health one do we suddenly feel that we just “don’t have time” for a 30 minute treatment so it can hit the cutting room floor?

Theres the wider issue. For me I wonder if one of the defining features of SAD is actually not lack of light or bodily changes, but the fact that we don’t adapt. In some species, the behaviours of taking on more fuel (carbohydrate craving is an early symptom of SAD) and resting is part of their seasonal rhythm. In humans however, our bodies start adapting and our modern instinct is in fact to resist and fight to maintain the same levels of productivity.

In my utopian world of optimal wellbeing, I would see people following a more seasonal approach to life. I am however a realist and I know that the western world is going to be a long time bending to this ideal. If however we continue to invent new ways of ignoring our bodies and circumnavigating basic needs, the mental health crisis thats slowly gripping society can only deepen.

Im glad to say that in the event I was at, the majority of attendees agreed that actually, we should be finding ways to secure 30 minutes of our day to attend to our mental health, not more ways of disregarding it. That isn’t a sign for complacency however. These small conversations and comments are symptomatic of a type of unintended stigma that, taken with ignorance and discrimination, is crippling the wellbeing of millions of people.

If you want to find out more about challenging the stigma of mental illness, please follow my new charity, Talking FreELY or get in touch with me.

Finally, if you are suffering from mental health problems, be assured, you are not alone and there is non judgmental help when you feel able to reach out for it. Again, check us out at Talking FreELY

“Depression isn’t a sign you are weak, its a sign you have been strong for too long”

Its a well intentioned way of re-framing how we perceive mental illness but what does it actually mean and is it accurate? For me the language creates some problems!

Firstly, its a bit of a sweeping statement because mental illness is completely arbitrary, affecting people from all walks of life and for any number of different reasons.

What it refers to more specifically is a commonly encountered cause of depression. The curse of modern western society. Stress!

The “strength” to which it refers describes the capacity of a person to cope with stress. In so called “strong” individuals, stress acts as a motivator, an impulse to push harder and harder to overcome the adversity and achieve. When the drive goes beyond the bodies limits there comes a point where it has to break, like any system that is overloaded. At that point depression takes hold.

If you are one of these individuals (its fine by the way, I’m a lot like that myself) you probably feel better knowing that in spite of your mental health, society views you in positive terms as a go-getter. In some cases, it may encourage the perception that mental illness is simply a consequence of normal life if you want to “get on”.

But what if you aren’t “strong”? By implication, if not in actual language, this statement suggests that the opposite, people who fold at the first sign of stress and therefore don’t push their body through the same level of trauma, are unlikely to suffer depression. Apart from this (of course) being absolute rubbish, the implication is that these types of people are “weak” (it is after all the opposite of strong), a term most of us would consider to be an insult. Society after all has little regard for this approach to life.

Am I over analysing? Well certainly if the message that we value strong over weak is not implicitly carried in this statement on mental health, it is one that is heavily implied and indeed replicated across society, particularly in the workplace where I have repeatedly encountered the attitude that “going the extra mile” is pretty much compulsory.

Of course the path you decide to follow in life is an entirely personal choice. Where it becomes problematic is when society guides these choices through negative stereotypes. When people push themselves because they feel that is what is expected, not what they want.

Can a statement intended to make people feel better about themselves really do this? I think it can. I think the stigma of mental illness is driven by thousands of stereotypes, cultural norms and poorly used language. In this example, you could as easily change strong and weak for stupid and wise and tip the entire statement on its head. Language is a powerful tool and tackling what has become accepted norm is a huge challenge. If however we ever hope to have a lasting impact on the merciless onslaught of mental illness its one we have to take on.

It all begins by talking which is why Talking FreELY invest so heavily in facilitating simple and honest conversations about mental health. Because it is these conversations that will drive change.

If you are struggling with mental health there are a number of useful links on the Talking FreELY website. If you want to know how you can help to keep the conversation, check us out on Facebook and Twitter

The theme of 2017 Mental Health Awareness Week is, surviving or thriving. When I first read this I was immediately drawn to the word thriving, a word that fills me with optimism and excitement about the potential the world has to offer. Immediately I cast aside survival as a negative message that I didn’t want to focus on.

Today I was reflecting as I often do and I realised that this is mental health awareness week, and Talking FreELY, a local mental health organisation I am involved with is about honest non judgemental conversation on metal illness. I realised my natural instinct to try and fix things had perhaps led to me missing at least 50% of the awareness message. Awareness is not about solutions, its about giving some insight and however hard those messages are to deliver it is surely my responsibility as a mental health ambassador to try and do so. So I would like to talk a little about survival and what that means in terms of mental health.

The first time I heard thrive or survive was on Chanel 4’s “The Island” with Bear Grylls. 12 contestants marooned on a desert island with nothing but basic tools and the clothes on their backs. The challenge, not just to get through, but to actually enjoy it. To eat well, to create a comfortable living environment and a happy community. I was watching this programme last night when the tail end of a hurricane hit the island dumping inch after inch of miserable battering rain on them. No proper shelter, no proper clothing, unable to go and hunt for food, barely able to keep a fire going and worst perhaps, inaccessible even by the rescue teams. It was utterly miserable and in that real life moment, any thought of thriving was lost and it became a single battle to get through that bad time. It is a great example of how life is, and how mental health can be.

My own mental health is an ever changing landscape. There are times when I do indeed thrive. During these times I can really rip into life and live each day to its fullest potential, laughing, joking, getting things done, the life, soul and energy of the party. But its not always like that. Several times a year, every year for as long as I can remember, my mental health will slump and the cloud of depression will loom overhead. In these times its often all I can do to get out of bed in the morning. I retreat from the world and everything from washing my face to taking the kids to school becomes a struggle. As I’ve grown in my awareness I find I have an increasing number of strategies that can help me to predict and manage these bouts. I lean more heavily on relationships, try where I can to get out more, stay off social media. These interventions help but they aren’t about thriving or “snapping” myself out of it. Surviving in these moments isn’t a choice under my conscious control. I don’t chose to be depressed or anxious any more than those poor people on the island chose to be battered by relentless rain. Its what life throws at me, and I do what I need to get through until the time passes and the sun comes out again. Some people may come out of it and never get hit by a hurricane again. For others, who live in their shadow, its about rebuilding and trying to be better prepared for the next time.

Perhaps I can be forgiven for focusing on thriving. The reality of survival isn’t that cheerful and who wants to be seen as the harbinger of doom? We all want to hear the positive messages. But this is mental health AWARENESS, not mental health utopia. In amongst the positivity we should perhaps, quietly acknowledge that a lot of people are just surviving and in fact may not need a bundle of ideas just now to get them thriving. Lets celebrate the successes but remember that the bigger task is in supporting the ever increasing number of people who are suffering from a mental health issue. How you survive is what empowers and enables you to thrive.

If you are suffering from mental health problems and need help, please follow this link for details of support organisations – HELP

The Time to Change charity have recently released a short film encouraging men to look for the signs of mental illness in each other and offer some support. It sounds obvious but the campaign identifies that only a third of men feel comfortable talking openly about their feelings.

A number of social stigma’s prevented me from accepting I was mentally ill for years. Fear of losing my job and my dignity, fears of tarnishing my future with a permanent label, fear of accepting the obvious and looking weak. Of course I risked destroying all of these with mental illness anyway but never the less I resisted facing up to the facts for years. Were my fears unfounded? Sadly I think not. Stigma and discrimination towards mental illness does exist but things are definitely changing. One of the things that surprised me when I first opened up about my mental health problems was how many people had been there (or were there). One in four will actually suffer a mental illness at some point in their life but that statistic means virtually all of us will encounter it and be affected in some ways. When I started up the Metropolitan Police Mental Health network, we were deliberately open about who we were trying to support. As such our membership grew not only with those suffering mental illness, but from those who were supporting family and friends, or who simply wanted to make a difference.

Thankfully I had mates in my corner who kindly but firmly encouraged me to face up to my illness and seek help.

I would encourage everyone to watch this video and think about how you can support the battle to end Stigma. It will help to save lives.

If you are interested in how acupuncture could help with your mental health please email me here

If you need urgent help for a mental health problem you can contact the Samaritans here

For more information on Time to change and how you can be involved click here

A story that caught my eye whilst perusing the media for “Health headlines” this week was an article discussing the results of a survey that found an astonishing number of women won’t seek medical help for so called “embarrassing” medical conditions.

Typically the survey was heavy on the “whats” and light on the “whys” so it left me thinking about why women wouldn’t feel they couldn’t talk to a medical professional about an intimate issue.

When I considered the process of getting to see a doctor myself, the reasons seemed clearer. Lets have a look at a potential encounter.

First you call the surgery. You may have to wait for quite some time on the telephone before speaking to a receptionist who will then enquire as to how urgent your need is. Thankfully at my surgery they don’t ask you what your problem is though I have heard of this being done in other locations. If you have a non urgent enquiry you will likely be offered an appointment a number of weeks in advance. It is very unlikely you will get to see the doctor of your choosing because everybody else wants to see them too and they will only book about 4 weeks in advance. You either have to plum for whoever is free or call back another time. If you say your need is urgent you will be referred to telephone triage and a nurse will call you back. You then need to discuss the basics of your condition on the phone with someone you have probably never met who will then decide how urgent your need is and offer you an appointment, again a pot luck of availability. At this point you have no idea of the extent of investigation your problem will require. Will you need to be examined? Will you need to discuss personal issues?

When your appointment finally comes round you have a ten minute window to discuss the issue. The doctor is under immense pressure to find the solution and update the computer. You may or may not have met them before. You may or may not have a rapport with them. They may or may not be having a good day. You may be asked to strip off and have an intimate examination. Have I sold it to you yet or do you think you might just soldier on with your ‘intimate problem’ until it either goes away or becomes unbearable?

The reality is that if you do need to discuss an intimate (Embarrassing is frankly an insulting term) problem there is a very high likelihood that you will be treated with a high level of professionalism and respect. There are policies and rules in place to ensure that a patients rights, dignity and safety are of paramount importance at all times. The problem is that we have completely lost the human element. Trust isn’t built on the basis of policy or rules its developed with empathy and consistency over time.

A few years back, everyone knew their family doctor. In our modern “rush rush rush money money money” society this is scarcely found and as a result health ‘care’ has become a process as appose to a therapeutic relationship.

So what is a therapeutic relationship and why is it important? Well thankfully I don’t have to work under the same pressure as a doctor so this element of healthcare is a more integral part of what I do. In practise it looks a little something like this: New patients are usually booked in for an hour and a half first appointment. We spend a long time discussing all aspects of their health. They may feel they can open up to me during this time, they may not, but they can come back and see me as often as they want, with or without current symptoms to work together on their health goals. Whilst i make recommendations, the patient dictates the pace and intensity of treatments. If we spot something unusual or potential of concern, we discuss the appropriate course of action. Where necessary (and always with permission) I will write to their doctor or other health professional. the patient feels supported and in control and hopefully able to talk to me about anything in safety and confidence because they have come to know me.

So obviously I’m suggesting our doctors follow this model? Well obviously in a utopian world this would be the ideal the solution but in the real world it simply isn’t practical. Health services are at breaking point already.

Where I think the compromise lies is in a fully collaborative approach. First of all, we as a culture need to stop viewing health as the status quo and invest in maintaining it rather than fixing it. Complementary therapies like massage, acupuncture, counselling can all play a part in improving how we feel about ourselves and give us the opportunity to form the type of therapeutic relationships that make us to feel safe and open about areas of health that give us concern. For our part, the health industry need to put the needs of the patient first and recognise the value of working with each other. Better communication rather than fighting and posturing about who is best, cleverest, right or wrong. Only this week I was listening to a radio programme where acupuncture was again dragged through the dirt over an area of medicine where dedicated professionals support patients through an enormously emotional and traumatic procedure. Perhaps its time we started focusing more on the benefits. There are plenty of cases where complementary therapists like myself have spotted potentially serious health problems simply because we’ve had more time to investigate, observe or examine a patient or because they have felt able to discuss concerns with us in the treatment room. When this happens we aren’t trained to sit there congratulating ourselves or make promises of miracle cures. We are trained to alert doctors or refer to the most appropriate form of treatment (always with permission I hasten to add).

To me this is integrated medicine. Health professionals working together to put the needs of the patient first and breaking down those barriers like the ones from this survey.

I remember the days quite clearly. Standing on the platform at about 5am, shattered, waiting for the train into work with several other miserable people all of us slaves to the wage.

My story is probably familiar. Job in London, moved out when I had kids so I could afford a decent house, longer commute as a result. To minimise the impact I had condensed my hours so instead of working 5 days a week I worked 4 longer ones. As a result I got an extra day at home on the weekend but the trade off was leaving the house at 4.45am and getting in at 7.30pm on a good day. If there was a delay, which there frequently was, it could be 9, 10 o’clock or dossing down with my in-laws because I couldn’t get home at all. It was a grind and although I still believe it was the right thing to do at that time, I never the less longed for a better life.

I’m not alone in challenging the status quo. In a recent survey 60% of respondents admitted they have a hard time maintaining a good work-life balance and most of the people I speak to would prefer to have more time to do what they want to do. But is it really what we want and if it is, whats actually standing in the way? I suspect we will all resonate with the same thoughts: Fear of the unknown, conformity with an ingrained culture, lack of appreciation of our own self worth. Yet if we can overcome, the rewards are priceless.

These days I work for myself. My acupuncture clinic is about a mile from my home in the shadow of Ely Cathedral and I’ve structured my days so that I can do the school run every day and see my kids both in the morning and the afternoon. I spend Monday and Friday at home catching up with paperwork and all of the other unspoken responsibilities of a small business owner. I don’t drive a flash car or live in a flash house but I live comfortably within my means. Most importantly the 5am train journeys to London lie firmly in my past.

What convinced me to change. When I reflect back on my own journey to work-life balance it happened over three distinct phases, all of which were symbolised by an event or metaphor. I believe that by adopting this three phase approach you too can get the life you want so I have summarised each with the lesson I learned below.

Photo by Jeremy Shultz on Flickr and used here with Creative Commons license

Step 1 – Challenge your relationship with money

Everyone needs money to get by in life but it is entirely fair to say that western lifestyle is driven less by need as by desire. In my lifetime alone we have added mobile phones, broadband and cable or satellite TV to the typical household budget. Stretch back a generation and the list wouldn’t even have included a TV. Undoubtedly we have become more dependant on mod cons and technology but when you strip it right back, our existence doesn’t actually depend on them.

For most of us, work-life balance means making some financial sacrifices so one of the first tasks is to get a better understanding of your own relationship with money.

I first started to think about money differently when I moved to Ely where the train station is Sandwiched between a large Tesco supermarket on one side and countryside on the other amongst which is nestled the Bridge Fen allotments.

I often pondered the irony of looking out longingly at the allotments, wishing I could be out in the fresh air growing my own food for my family when instead I was travelling to work to earn money to spend in the supermarket on inferior quality produce because I was too busy earning the said money to spend any amount of meaningful time growing my own!

You may want to read that again a few times to get your head around it but in summary, by my reckoning, the lost income from trimming my working hours could have paid for itself in better quality home grown food. Looking even more laterally at the savings, I could have most likely cancelled out my monthly gym subscription too on the natural exercise I would get maintaining an allotment.

Now I should point out, I haven’t changed my life by growing veg (though it still sits at the back of my mind in the “to-do” pile) but it was this simple observation that set me to changing my whole way of thinking. Once I broadened this simple perspective I started looking at how I spend all of my money and asking hard questions about want over need. Do I need an expensive house? Do I need an expensive car? What can I get by on. If I don’t want to get by, how much will it all cost? This isn’t to say I live a frugal existence. There are many “wants” amongst my expenditures, the luxuries I feel give me the right balances in life, but what I did, and what I advocate for those who want to change their lives, is to really analyse expenditure, challenge your thought processes and in doing so set out your priorities. Do I need it, will I use it, will it make me happy? Cant afford your mortgage? Sell your house and buy a cheaper one. Already on the first rung of the property ladder? Sell and rent, move abroad, live in a caravan. I know it sounds drastic but you really need to get to the bottom of what drives you.

I could buy a bigger house, I chose not to because it gives me the freedom to work less hours and spend time with my kids. The point is that Financial freedom is an option for most of us once you peel away your manufactured barriers.

Step 2 – Find the right role in life

Photo by Carmela Nava on Flickr and used here with Creative Commons license

Actually this came to me last but Ive put it here in the chronology because (for reasons that become clear later) my own experience suggests that it’s a better fit sooner in the process.

For some people, the pathway to work life balance is going to be easier than for others. Some jobs lend themselves to part-time hours or flexible working. Others can make an easy transition to consultancy or agency work. But what about those of us who don’t have an easy transition or who are looking for a complete change?

For many years I had longed for the freedom of working for myself. Trouble is, I’m risk adverse. My dad lost heavily in a business venture back in the 80s and as a result growing up was hard. Jumping into the unknown and potentially investing speculatively on a business terrifies me and no matter how miserable I was the safety of my situation took priority over my happiness. It didn’t stop me dreaming though and I spent days and weeks in contemplation and conversation with family and friends trying to find the perfect plan. I got nowhere except frustrated.

My inspiration came from an unlikely source, a discarded newspaper on the train that I’d have normally ignored. This day however I picked it up and chanced upon an article about a person who had won a slimming title after losing a phenomenal amount of weight. I wasn’t really interested in the story and almost put it down but just at the end I saw a short sentence which read – “now works as a slimming consultant”. The simple idea of using your own experience to coach and inspire others made complete sense and as I thought it through I realised there were other examples. Reformed drug addicts working in rehabilitation, former gang members working with inner city youth’s and many more where life experience translated to work. From that moment I set my future career path on doing the same thing.

It was an exciting moment because I knew that this was a safe bet. I was investing in myself and as such had as much control over the investment as its possible to have. But what did I have that people wanted? The answer was simpler that I’d have thought. I’d stepped back from the world and looked at it from a different view point and when I looked around, realised that lots of other people are striving to do just that. I was going to change my life and in doing so improve my health and then I was going to help others who were stuck! I walked down a couple of dead ends before I decided that Acupuncture would be the vehicle for delivering my aims but once I’d decided what my “purpose” was the rest became simply about getting the right tools for the job.

Now it may well be that you have a clear idea of what you want to do. Braver people than me may chose to really go for it. If however you are like me and struggling to see what you have to offer the world my advice is to look a bit closer to home. The answer may be a lot closer than you think.

Of course all of this insight and self realisation is just the preparation. You can buy the best parachute, get the best training and lay out the softest landing but whichever way you sugar coat it, you will eventually have to jump and that takes either courage or an almighty shove.

My encouragement came from a good friend who used to listen with good grace to my daily moans and complaints, crazy business ideas and mad-cap plans for a future that was apparently getting no closer. He would simply say to me, “Tony, you need to step off the merry-go-round”. And you know what, this metaphor encapsulates the whole experience of change so beautifully I cant think of any better way to put it! I wouldn’t however recommend getting off the same way as me. I half jumped and was half pushed when we were spinning pretty fast. I failed to hit the ground running and as a result fell flat and hard. You can spare yourself some pain by slowing the merry-go-round down and having a few steps planned before you jump! That said my fall became part of my toolkit. I got up, fixed myself and here I am now sharing the experience to spare others so I guess it wasn’t all that bad!

Bringing it all together

Embracing a work-life balance isn’t an easy task and there are times when it feels the world is against you. Society embraces quantitive success where achievements are measured in pounds and pence and it takes a brave person to challenge this and live their life to qualitative values.

What I can say, from personal experience, is if you can embrace the change a happier healthier life is almost certainly awaiting . Most people will secretly hanker after everything you have gained and actually, far from mocking will probably applaud you.

Good luck with your journey.

Tony is a former Metropolitan police sergeant now working as an acupuncturist in Ely, East Cambridgeshire and is available for private appointments or corporate presentations/events. Details of how to contact him are given here.

Photo by paurian on Flickr and used here with Creative Commons license.

The issue of science and evidence based medicine has interested me since I first entered the profession of traditional acupuncture. I am fascinated by the far reaching capabilities of science, particularly how modern thought correlates with the traditional philosophical concepts of health that still form the main foundation of traditional Chinese Medicine. It is through this respect however that I have also learnt the limitations of what human beings can explain or understand.

The evidence base for acupuncture is a big subject in which many pitch battles are fought, usually between the relatively niche worlds of scientific skepticism and research savvy complementary therapists. Its dominated by big brains and personalities and an arena into which I feel intimidated to even dip my toe. However! The recent episode of BBC’s “Trust me, I’m a Doctor”, in which they tackled the question “does acupuncture work” in about 8 minutes has convinced me to offer some observations that may better equip people to make a more informed decision for themselves.

Historical context

Acupuncture has been researched since the 19th Century and appeared in the first ever issue of the world acclaimed medical journal The Lancet. The scientific interest however gathered momentum in the 1950’s when Chairman Mao established a number of acupuncture research institutes as part of a “reinvention” of traditional medicine”. This and an increasing interest in acupuncture from the scientifically minded west led to a substantial amount of acupuncture research. It is now most likely the most widely researched complementary medicine in common use.

Photo by Jeremy Shultz on Flickr and used here with Creative Commons license

The Gold Standard of Evidence

When we hear about scientific evidence in medical terms it is really defined by the Randomised Control Trial (RCT) which is considered the Gold Standard of evidenced. In order to establish how well a particular treatment or intervention works it is studied alongside one or more “control groups”. Trial subjects are randomly allocated to one of the groups or “streams” in which they will receive either a treatment or a control treatment. In the best studies one of the control groups will be treated with a placebo i.e. designed so that the person giving and receiving it cannot differentiate from the active treatment. In a blind trial they will have no idea which treatment they are getting. In a double blind study the practitioner will also be blind as to which treatment they are giving. In its simplest terms a positive outcome would see the tested treatment or intervention outperforming the controls in a statistically significant way. Sounds simple? Its not. Its a complex time and resource intensive process. There are numerous quality indicators within the process and any deviation risks invalidating or at least undermining the entire study.

Difficulties of designing and RCT of Acupuncture

Firstly, there are a lot of poorly designed studies out there and I’m not decrying the ones that say acupuncture doesn’t work. Actually the opposite. Some of the early studies of acupuncture that consistently found it to be better than sliced bread aren’t worth the paper they are written on.

There are of course good ones too and it is in some of the larger and better quality studies of acupuncture that we hear one of the commonly cited criticisms that ‘whilst acupuncture outperforms “usual care” with statistical significance, it fails to compare so well to sham acupuncture’. This is interpreted by many as meaning it is no better than a placebo. I think we should consider more information before leaping to this conclusion.

Lets be clear, RCTs are designed for and lend themselves to researching drugs. In this type of research, creating a placebo is a simple matter of handing the subject a pill or liquid without any active ingredients, usually a sugar pill. The subject takes it as they would any other drug and in the main, this is a direct representation of how a patient would be treated with drugs.

For interventions using holistic therapies like acupuncture it is far more complex. Typical clinical practise for a traditional acupuncturist involves a great deal more than just needling. Palpation, case history, lifestyle advice, the list goes on. And then there’s the needling, tailored individually to the patient and their unique presentation. Many trials of acupuncture use pre-defined acupuncture points and seek to isolate it from the other parts of treatment like lifestyle advice etc. You end up with a highly sanitised treatment that bears little if any resemblance to a typical clinical encounter.

The issue of using a placebo control is also highly controversial. Creating a placebo for acupuncture means designing an “act” for real and false acupuncture that nobody can differentiate. The favoured methods are retractable needles that don’t penetrate the skin or normal needling on “non” acupuncture points. The latter at least involves needling which arguably activates a bodily response making it far from inert. The former is also far from infallible. During a practise sessions with various types of non-penatrative placebo needles I found that in fact they frequently break the skin and this corresponds with the experience of research acupuncturists too. If they penetrate the skin, can it be considered as a placebo or non-active intervention?

I’d suggest not so what you end up with is a placebo that may not be inert and an intervention that does not represent normal clinical practise. Yet in spite of this, both still outperform usual care. What does this say? My interpretation is that even bad acupuncture is better than usual care or no treatment. Imagine the potential for proper acupuncture!

Other evidence

What really grates on me is not the never ending argument of the wether or not an RCT has proved one thing or another. Its the hailing of an RCT as the be all and end all of evidence like nothing else in the world matters. I think this is demonstrative of a far larger cultural shift driven by advances in technology, not just our attitude to medical science. For example, in my previous profession of law and order we used to solve crime long before CCTV and DNA evidence (I hear the cynics amongst you! Lets have that debate another time!) Now it seems that witness testimony doesn’t really cut it. We need concrete proof and undisputed computer audit trails. Does this mean that without them the crime never took place, that the evidence of a witness was wrong? No, its just that we now have a higher expectation. The same is true of medical science. The old evidence is still evidence and actually, if theres enough of it or the “new” evidence is poor evidence it is arguably still “best” evidence! Thats not to knock progress, just to encourage some humility because our expectations now are so high we seem to forget that in the greater scheme of things we actually still know very little. Anyone who has suffered a migraine will back me up here. Drugs may work, they may not, they may work for a time then stop working. Actually, this commonly occurring but painfully debilitating illness is very poorly understood in spite of countless studies and amazing scientific developments.

Traditional acupuncture does not rely solely on what can and can’t be proved scientifically. It is built primarily on the collective knowledge of recorded clinical practise over 2,000 years. It is good evidence stood next to science which has only really developed in the last 60 years and still has a long way to go. I wonder then why some people would be so quick to dismiss it.

Conclusion

Photo by Tori Rector on Flickr and used here with Creative Commons license

I hope that I have been able to give a good overview of the strength and potential weaknesses of scientific evidence in the field of acupuncture. In my opinion, whilst science has a huge part to play in our future, it still stands very much in support of the historical knowledge and philosophy that is the bed rock of traditional acupuncture. That doesn’t mean Im not excited about what it can and will bring to my profession as we make more and more advancements . I simply advocate tempering this with an awareness of our own limitations and the openness of possibilities beyond our own limited knowledge.

In the meantime I will continue to be guided by “all of the evidence” to treat individual health needs with traditional acupuncture for as long as it continues to help people. I have a feeling I won’t be retiring anytime soon!

Photo by thornypup on Flickr and used here with Creative Commons license.

Everyone is stressed! Its a 21st century epidemic because we work too hard and want too much. Examining the complexity of stress and how to overcome it is the basis of a deeper and more detailed story but there are some simple steps you can take to start off along the pathway.

1. Turn the technology feeds off – Yep I’m talking all of them. E-Mail, Facebook, News, Twitter. Did you know that there are now more mobile devices than people in the world ? There is increasing evidence that we are becoming addicted to technology. People are absolutely bombarded with information and it sits right there at our fingertips, bonging away every five seconds on a smart phone. Do you really need to instantaneously know that you mate just checked in at the gym or the Bank of England reduced the base rate by 0.25%? Will your mates gym session go any better for you “liking” it? No. Thats not to say we shouldn’t enjoy our technology. Just be more disciplined about when you use it.

2. Switch yourself off – When I ask people how they relax the most common response I get is “Watching TV” Lets explore this. Is TV designed to help us switch off? No. Switching off is the last thing the TV bosses want us to do. What do you watch? X Factor? The News? Soap Opera’s? Think about whats happening emotionally when you do this. Excited? Angry? Jealous? Watching TV may be giving your body a rest but not your mind. I recommend mindfulness as a way to regenerate the brain as its simple and accessible. You can find a wealth of resources out there to help develop your technique but if you want to just give it a go why not try practising a breathing technique and focusing on the breath for a few minutes each day. You will be surprised at just how busy your mind is!

3. Go for a walk – This has 2 benefits. Firstly, you get some exercise. A lot of my patients don’t register walking as exercise because we seem to only register physical activity with going to the gym. Actually the traditional Chinese view of health would take quite a dim view of all that heaving straining and sweating. Traditional exercises such as Tai-Chi are far more sedate but get the blood and energy flowing all the same. The second advantage of walking is you get some natural light. Studies of seasonal affective disorder suggest a clear link between natural light and mood so getting this into your daily routine is really important, particularly since so few of us now work outside, instead staring at manufactured light on computers all day. Get outdoors and revel in all that fresh air! If the suns out even better since sunlight is a natural source of vitamin D!

4. Sit down and eat properly – This isn’t a diet lecture. There are a whole bundle of resources out there on what you should and shouldn’t eat, some good, some rubbish. I do give dietary advice but one of the most overlooked aspects about food is how you eat it which is arguably as important as the food itself. Buying a healthy lunch then shoving it down at your desk between meetings is a waste of good food. Eat 3 times a day, every day, and take enough time to sit down and eat these meals properly, preferably at a table, but at least without distractions like TV, work and yes those retched smart phones again! You will digest better and therefore feel better. Less indigestion, more energy and who knows, you may even lose weight. Once you’ve nailed that we can start thinking about what type of food we actually put in!

5. Give yourself a break once in a while – One of things we struggle with in the West is this sense that one shower ruins the summer. If we have a chocolate bar our whole diet is a failure. Its a huge barrier to progress because rather than seeing it as a set back or a one off it becomes the end of the line. Out comes the ice-cream, on goes the Shakira (Bridget Jones for those who missed the reference). What we miss is the massive triumph of the 1, 2, 10 days before. Life is for living and whilst having self discipline is a wonderful thing having fun is an essential part of life too. If you fall off the wagon, remind yourself you’re human, applaud yourself for everything you’ve achieved AND for recognising your human limitations and start again tomorrow.

So they they are. 5 simple steps on a long journey. Thank you for reading and good luck. Do remember to check in again for more health a wellness tips.

Written by Tony Sigrist

Tony is a qualified Acupuncturist with a lot of experience in managing mental health. He is available for talks and presentations to businesses and groups and also has a private practise in Ely Cambridgeshire where he see’s patients for individual support across a full range of physical and mental health conditions. Contact him today to discuss your individual needs.